Approximately 20% of all children in the U.S. will have at least one Emergency Department (ED) visit each year. Patients and caregivers expect clinicians to deliver high quality emergency care, yet many children do not receive appropriate care under the current system. The Institute of Medicine report, "Emergency Care for Children: Growing Pains," notes that the delivery of care should be built on a strong foundation in which emergency care is based on scientific evidence, data are collected so clinicians can learn from past experience, and system performance is monitored to ensure quality. While EDs routinely collect substantial patient data with the potential to provide information on the quality of care provided, the capacity to capture, analyze and report these data back to front-line clinicians capable of acting to improve health care delivery has been limited. Leveraging advances in health information technology to access patient-centric clinical data, researchers can measure and identify variation in performance and outcomes, enhancing the ability to design and implement interventions to improve outcomes and quality of care across multiple settings. The increasing use of the electronic health record (EHR) in EDs provides a unique opportunity. Utilizing the infrastructure of the Pediatric Emergency Care Applied Research Network (PECARN), this proposal will innovatively capture EHR data to implement and report performance measures with the ultimate goal of improving the quality of emergency care for children. This proposal will develop an emergency care visit registry for pediatric patients from EHR clinical data which will serve as the foundation for the current and future studies, precluding the need for resource-intensive chart review. Emergency care performance measures will be derived from registry data and we will measure variability among sites and individual clinicians. Data from the registry and qualitative methods will be used to set benchmarks of care. We will design site- and clinician-level Quality Performance Measure Report Cards that will be generated from the registry and distributed monthly. The registry will be utilized to evaluate the performance measures in a prospective manner for improvement in the measures themselves as well as decreased variation in performance across practitioners. Significant improvements by individual practitioners should also manifest as improvement at the site level. We will test the hypothesis that providing regular performance measure feedback will improve performance and decrease variation among ED clinicians using a staggered time-series study. The proposed project, thus, has enormous potential to improve our ability to evaluate systems of health care delivery, as well as to lead to improvements in the quality of care provided to acutely ill or injured children. Although this proposal centers on health care delivered to children in EDs, the principles delineated apply to all components of the healthcare system that collect electronic patient data. Accordingly, this proposal should be viewed as having wide applicability for comparative effectiveness research and quality improvement across all healthcare domains. PUBLIC HEALTH RELEVANCE: Every day, 80,000 children seek care in emergency departments (EDs), these patients and caregivers expect emergency clinicians to deliver high quality care, yet many children do not receive appropriate treatment under the current system. We intend to establish a data registry from electronic health records to collect and report quality measures of emergency care provided to children. We will establish measurable benchmarks and implement a clinician feedback intervention to improve performance;this proposed project will allow systematic and widespread collection and reporting of performance and outcomes and is critical to allow clinicians and emergency care stakeholders to improve care beyond the local level.